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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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“An Unnecessary Effort”: Wuesthoff Health Pays for EOB’s

Unnecessary (ŭn-nĕs’ĭ-sĕrē) adj.

  1. Not necessary; needless.
  2. Serving no useful purpose or function

You have got to love it, huh? Did you see the most recent series of lawsuits just announced by the AMA. They must just be loving the opportunity to pile on their arch nemesis insurance companies at a time when their very future is in question.  It looks like the “price of opacity” is going to get a lot higher (will blog on that later).

Apparently, there is also a “price of transparency” being offered up in the market as well. In a very interesting article (a take off of my Million EOB March post?) from Wuesthoff Health System revealed that they are actually paying consumers to have access to the EOB’s from other hospitals for specific prices of procedures. Wuesthoff is obviously interested in this information for a variety of reasons, including general business intelligence, competitively pricing their own health services, and to optimize their business operations. Paying consumers $100/EOB to get this information is revealing in that this is what is required to obtain market information in health care – we have to resort to these types of tactics (which I applaud!).

Couple comments:

  • Social Networking tools as Collective Intelligence engines – I am an obvious big fan of Health 2.0 technology not for the buzz but rather for the bang when they are actually applied to meaningful problems. Utilizing collaborative pricing tools like Change:Healthcare that allow consumers to contribute to the overall knowledge of something (by sharing information) can be powerful. I believe incenting them to do so might be a great investment by not only gathering the information but ultimately breaking down the entire opaque pricing schemes of the insurance industry
  • Competing on Networks vs. Competing on Value – For too long insurance companies have competed on their ability to aggregate the broadest swath of physicians for the cheapest prices. The hold down costs by paying way less than market rates. Physicians respond by jacking up their retail prices to make up for lost revenue from insurance and the end result is everybody loses. The siren song of “increased volume” seduced many physicians, but those same physicians are now rejecting the “hamster wheel” medicine that it created. Instead of competing on the prices they can coerce in the physicians into taking, they should instead by competing on teh value they can create for their members. They should be offering tools, technology, alerts, and reminders that actually help their members stay healthy, that add to their ability to care for themselves, and to optimize their own health. If Insurance companies can’t do this, then they SHOULD be reduced to claims transactions shops that get commoditized.
  • “Completely Unnecessary effort, just pick up the phone and call us” – this was the money quote of the entire article from a competing health care organization, Health First, public relations team. Come on! Really – I can just pick up the phone and your going to tell me any of the prices I would like to know? If that is the case, why don’t you just publish your prices – both the retail as well as what you have agreed to pay to accept from health insurance companies. We all know that retail prices are IRRELEVANT, so only the contracted prices (as contained in EOBs actually matter). And because I seriously doubt organizations will provide contracted rates, I’m guessing we are left to aggregating EOB’s to get some real pricing information. And now, because of social collaboration tools, the information available in EOB’s has the very real potential to be aggregated and available to all.

Be kind, save your neighbors some gas money, and REALLY make all this “petty” price gather efforts UNNECESSARY by posting your prices.

A $100 gas card says you won’t do it . . .

UPDATE: I received a call back from the Health First Public Relations person mentioned in the article. He was straightforward in informating me that this “Pay for EOB” concept was less about transparency and mostly about an anti-trust lawsuit that Wuesthoff and Health First are engaged in. Apparently, the pricing issues are an essential part of the lawsuit and instead of using typical legal discovery tools, Wuesthoff has appealed to the public to gather this information as well as pick up some additional publicity in the process. While this little wrinkle puts somewhat of a damper on the motivations behind doing this, the concept of increasing pricing transparency remains an important element in helping people obtain the best health care value.

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